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How will I know if my child has a UTI?

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If you have ever suffered from a urinary tract infection, you will know how painful it is to pee. Unfortunately, the symptoms of a urinary tract infection (UTI) may not be obvious, especially in very young babies. Just as children are prone to sniffles and coughs, so children suffer from urinary tract infections too. Urinary tract infections affect around one in 12 little girls and around one in fifty boys under the age of seven years.

Parents often ask me how or why their baby got a urinary tract infection. To answer the question, I usually begin with a bit of a biology lesson to show parents how everything that has to do with making a pee works.

Let’s begin with our lesson:

Kidneys – Their job is to filter waste and extra water out of the blood to make pee (urine)
Ureters – little pipes connected to the kidneys. These send pee (urine) from the kidneys into the bladder
Bladder – The bladder is the organ which stores the pee (urine)
Urethra – This empties the urine out of the body via the vagina or penis.

What causes a UTI?

A urinary tract infection happens when bacteria get into the bladder or kidneys. The most common source of these bacteria is the baby’s skin (especially the skin around the anus and genitals) or poo. The bacteria get into the urinary tract and begin to grow. Bacteria may also enter the bladder or kidneys via the bloodstream, but this is less uncommon.

Baby girls are more likely to get a urinary tract infection because the urethra is shorter than the urethra in boys. In addition, bacteria from a poo nappy can get into the vagina and urethra of a baby girl more quickly than it can into a little boy’s penis.

Other causes include:

An abnormal pee (urine) flow from the bladder up the ureters and towards the kidneys. This is known as vesicoureteral reflux (VUR). In other words, the pee is travelling in the wrong direction.
If there is a block somewhere along the urinary tract. The urine sits in the tract, and germs can grow.
A malformed kidney which is unable to flush the waste from the body.
Holding onto pee for too long or poor hygiene habits ( not wiping correctly)
A family history of UTIs
Constipation can also cause blockages in the urinary tract and allow bacteria to grow.

How will I know if my child has a UTI?

As I said in the earlier part of the blog, UTIs are less obvious in tiny babies, so one must look for signs of infection. These may include:

Fever
Excessive crying and irritability
Lethargy or excessive sleepiness
Blood in the nappy
Strong-smelling pee
Poor appetite
Vomiting
Poor weight gain

In older children who can communicate or are potty trained:

They express pain and burning when they need to pee
They seem to want to pee more often, but then only little drops are passed
Fever
They may wake up often at night to go and pee or even start bedwetting again.
Tummy pain, most often just below the belly button.
Pee that smells bad
Cloudy or blood-stained pee

Most UTIs occur in the lower part of the urinary tract. Let’s go back to our biology lesson. The lower part includes the urethra and bladder. This type of infection is called cystitis, the most common type of UTI. It is also the easiest to treat.

If the infection travels up the ureters and into the kidneys, it is known as pyelonephritis. This is more serious than cystitis; the child is usually much sicker. The symptoms of fever, pain, extreme tiredness and vomiting are common in this scenario.

How does a doctor diagnose a UTI?

If you, as a parent, notice any of the signs above or cannot figure out why your baby is crying a lot, take your child to the doctor.

The doctor will need to get a urine sample to check for bacteria. It is critical that your baby or child is thoroughly cleaned before a sample is taken. Remember that urine is sterile and bacteria-free if there is no infection. If any normal skin bacteria or vaginal sluff gets into the urine, it will present as an infection. You do not want to be giving antibiotics to a child unnecessarily.

Your doctor may collect the pee in several ways:

If your child is still in nappies, using a urine bag is the easiest method. This is a little plastic bag that is placed over your baby’s genitals to collect urine. The bag sticks to the skin and is not painful. Understandably, it is more challenging to attach to a girl than a boy.
Your doctor may opt to put a tiny tube (catheter) into the bladder to ensure a clean catch with no skin contaminations.
In rare situations, the doctor may need to put a needle into the bladder through the tummy wall to get this sample.
In older children, one can get the child to pee into a little cup.

Your doctor will most likely dipstick the pee first. This involves dripping some of the pee onto a stick. If any abnormalities appear, the pee will be sent to the laboratory for further testing.

In the laboratory, the pee will be cultured. This is a process to look for bacteria in the pee. It will also tell the doctor which bacteria is growing in the pee so that the correct treatment can be given. It can take anything up to 72 hours to have a final result.

Your doctor will most likely prescribe medication if the dipsticks are abnormal. This is very important to prevent the infection from spreading.

If your child has had multiple UTIs, further investigations are necessary to check the functioning of the whole urinary system. This may include:

An ultrasound- this test is performed in the X-ray department. The ultrasound uses sound waves to show if there are any blockages in the tract or problems with the kidneys.
A VCU – This is a more complex and lengthy test. The Voiding cystourethrogram (VCUG) sends fluid into the bladder through a tube to show if there are any problems in the urethra or bladder when your child pees.
Nuclear scan – This test uses a liquid containing a tiny amount of radioactive material to see how the kidneys function.
CT scan – A CT scan (computed tomography) is a powerful X-ray that can take pictures of the organs in minute detail. The bladder and kidneys could be closely examined using these images.
MRI (magnetic resonance imaging)- This is a costly but effective method to take pictures of the bladder and kidneys. This is often not required.

What is the treatment for a UTI?

Many parents will not want to hear this answer, BUT a UTI must be treated with an antibiotic. If a UTI is left untreated, it can lead to a kidney infection. Infection in the kidneys is severe and may result in the child developing a kidney abscess, swelling of the kidneys, damage to the function of the kidneys and even sepsis.

If your baby is under 3 months of age, they often require admission to hospital for the antibiotics to be given via a drip.

Babies older than three months can be treated on oral antibiotics at home. However, certain resistant bacteria may require intravenous antibiotics even in older children.

Having your child’s urine rechecked after the antibiotics are finished will be necessary to ensure the infection has been cleared.

An antibiotic course is usually given for 7 to 10 days. Your child must finish the full course. Your child will most likely feel better after the third day of antibiotics. Please let your doctor know if the treatment is not helping the symptoms after three days.

Cranberry juice is widely known for supporting the bladder, but please don’t use it as a treatment if your child has symptoms of an infection. Your child will require an antibiotic to treat the bacteria.

How do I prevent my child from developing a UTI?

If your child has any urinary tract abnormality, then your baby may suffer from UTIs until the problem is rectified.

For children with a normal urinary tract, there are precautions that one can take. These include:

Frequent nappy changes. This will prevent the bacteria from the poo from getting into the urethra.
Once your child is potty trained, teach them to go to the toilet when they feel the urge and not to hold their pee in. At school, children are often shy to ask to use the bathroom, but the dangers of doing so should be explained gently to them. Holding pee in their bladders for too long gives the bacteria a place to grow.
Teach girls to wipe from the front to the back. This will prevent any bacteria on the skin around the anus from getting into the vagina and urinary tract.
Little girls should avoid bubble baths and scented soaps. These products can irritate the skin and cause bacteria to grow.
Little girls should only wear cotton underwear. Nylon causes sweating and encourages bacterial growth, while cotton allows for good airflow, which prevents the bacteria from growing.
Your children should drink plenty of water. Fizzy drinks and those containing caffeine cause bladder irritation and can lead to UTIs
A well-balanced diet that contains fruit, vegetables, and whole grains will ensure that your child poos normally. A constipated child will have more bacterial growth in the intestine, which can undoubtedly encourage UTIs.

Conclusion

A UTI is not an unusual finding in a baby. If a parent comes to my practice with a baby who appears to have “colic”, I will first test the urine. UTIs can go unchecked and have the baby and parents unhappy for weeks. This can also be dangerous. There is much to consider when raising a child, especially in the first couple of weeks. If your baby is crabby, challenging to settle, cries, or fusses when being fed, get the urine tested. A simple bag and a dipstick may be required to exclude a urinary tract infection. If the baby has a bacterial infection that is not addressed, then more serious consequences may arise.